International
Epidemiology of Child and Adolescent Psychopathology: Findings
for Diagnoses and Dimensions in Many Societies

Two related
articles have presented findings pertaining to child and adolescent
psychopathology assessed with standardized diagnostic interviews
(SDIs) and dimensional rating instruments in many societies.
The first article reviewed findings on the prevalence of disorders
identified by SDIs in epidemiological samples of >300 children
in >5 societies (Achenbach et al., 2012). The percentage
of children qualifying for >1 diagnosis ranged from 1.8%
in India to 50.6% in the U.S. The big difference in the prevalence
of diagnosed disorders might suggest that psychopathology
is very rare in India but very common in the U.S. However,
other studies have yielded substantially higher prevalence
in India and lower prevalence in the U.S. Because SDI studies
have differed so much with respect to the diagnoses that were
assessed, the informants (children and/or parents and/or teachers),
and the methods for using informant data, these methodological
differences preclude drawing firm conclusions about true differences
in the prevalence of diagnosable disorders. Greater standardization
of SDI procedures is therefore needed to achieve more accurate
prevalence estimates.
The first article also reviewed findings from dimensional
rating instruments used to assess children and adolescents
in different societies. The data have been subjected to confirmatory
factor analyses (CFAs) to test the generalizability of their
dimensional models, and their scale scores have been statistically
compared across societies. The five dimensions of the Strengths
and Difficulties Questionnaire (SDQ) have been supported in
some CFAs, but a 3-dimensional internalizing-externalizing-prosocial
model has been supported in epidemiological samples. The few
direct statistical comparisons of SDQ scale scores from multiple
societies have yielded smaller differences than were found
for diagnoses made from SDIs. However, the differences were
large enough to argue for norms that take account of population
differences.
The second article reported findings and clinical applications
based on data from population samples assessed with the CBCL/6-18,
TRF, and YSR in 44 societies (Rescorla et al., 2012). CFAs
supported the CBCL/6-18 and YSR 8-syndrome model and the TRF
7-syndrome model plus 2 TRFAttention Problems subsyndromes
(Inattention and Hyperactivity-Impulsivity) in all samples.
Considerable consistency was also found in the problems that
received relatively low, medium, or high ratings in the various
societies. Statistical comparisons of scale scores showed
great uniformity for age and gender effects across societies
but enough differences between societies in the magnitude
of problem scores to warrant separate norms for societies
with relatively low, intermediate, or high problem scores.
Clinical applications of the different sets of norms were
illustrated.